The treatment of recurrent pelvic organ prolapse is challenging. The pelvic floor symptom needs to be treated, a high quality of life has to be ensured and complications have to be minimized. There is a wide range of surgical options that may be used. The surgeon should be able to discuss and offer native tissue procedures for prolapse. In addition, for the clinically challenging situations of recurrent prolapse, mesh augmented procedures may need to be discussed with the patient. A thorough knowledge of mesh and graft options, as well as knowledge of prolapse recurrence and adverse events rate, can help guide clinicians in counseling their patients effectively. Ultimately, this will allow surgeons to choose a personalized treatment option that best align with a woman’s lifestyle and treatment goals. In this chapter the anatomical concepts of supports of vagina are elaborated. The pelvic diaphragm, lateral attachment of vagina to arcus tendineus fascia pelvis, intrinsic and extrinsic sphincter control mechanisms are elaborated. The surgical techniques of suspending the vaginal vault with autologous tissue and synthetic mesh are discussed. Finally, the role of minimally invasive surgery of pelvic floor is discussed as an integral part of management of recurrent vaginal prolapse.
Part of the book: Pelvic Floor Disorders
The genetic code information programs the embryogenesis. In this chapter the three phases of prenatal development the pre-embryonic, the embryonic and the fetal are elaborated. The role played by transforming growth factor beta related genes in the growth and differentiation of early embryo will be described. The implications of Fibroblast growth factor gene in binding heparin its effect on cell survival and mitogenic pathways is discussed. The orchestrated symphony of Sonic Hedgehog genes in early human embryo development is elaborated. The Homeobox genes (Hox gene) and their role in early human embryogenesis are described. The different tests available for prenatal genetic testing are briefly described. Preimplantation genetic diagnostic procedures are indispensable in clinical embryology. The microsurgical techniques of the Polar body biopsy, Blastomere biopsy and Blastocyst biopsy are discussed at the end of the chapter. A diagrammatic representation of individuals and relationships in clinical genetics is described. A brief description of procedures of invasive fetal tests for collecting the fetal tissue is also discussed.
Part of the book: Genetic Diversity and Disease Susceptibility